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Commonwealth <br />of Massachusetts <br />Form CPF R1: Itemization of Reimbursements <br />Municipal Form <br />Office of Campaign and Political Finance <br />File with: <br />City or Town Clerk or Election Commission <br />11/30/2014 <br />Griffiths, Thomas <br />Individual Being Reimbursed <br />Tom Diaz for School Committee <br />Committee Name <br />$141.95 <br />Amount of Reimbursement <br />10/27/2014 <br />Date of Reimbursement <br />Signed under the penalties of perjury: <br />Candidate's /Treasurer's signature (in ink) <br />Date Vendor Name and Address Amount Purpose <br />10/24/2014 U. S. Postal Service $129.20 Postage <br />Massachusetts Ave <br />Lexington, MA 02420 <br />10/24/2014 Wales Copy Shop <br />1810 Massachusetts Ave <br />Lexington, MA 02420 <br />$12.75 Card Stock <br />Date <br />